Culturally Appropriate Geriatric Care: Delivery of Care

Decision-Making and Disclosure

Short of a formally designated decision maker for healthcare issues, decision-making, in a very traditional Japanese family, is a family matter and follows a hierarchy. The first decision maker would be the husband or spouse. Next in line would be the oldest adult son, though the son would most likely make a decision compatible with what his parent and family would want. In a very traditional family, one would not see “open discussion and arguments” in front of a physician, as this act would be shameful and reflect negatively on the family name. The physician should be respectful by seeking and approaching the appropriate family member.

Traditional Japanese elders often place less value on personal autonomy as opposed to group or family consensus. In this regard, group or family decision-making led by the appropriate hierarchically designated family member may be the preferred model for decision-making. In the West, disclosure is the norm and is related to personal autonomy and it is felt that without disclosure, a person cannot be expected to make an informed decision and, thus, exercise personal autonomy.

In the traditional Japanese society, full disclosure to the patient, such as in terminal cancer, may not be acceptable or valued. It is felt that such disclosure may lead the patient to possibly give up hope, not fight the illness, or become depressed. The family often serves as a buffer and filter. As personal autonomy is less valued in a very traditional Japanese family, full disclosure to the patient is less relevant if decision-making falls on the group or family.

Studies of acculturation have suggested that group decision-making might be preferred even with an increasing gradient of acculturation (Matsumura et al., 2002; Bito et al., 2007).

Japanese American elders may also want to avoid being a burden to their adult children or other family members. Decisions might then be based on the perceived degree of burden upon loved ones.